Practice ABC of Breast Diseases, 4th Edition

Mastalgia

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f3288 (Published 13 December 2013) Cite this as: BMJ 2013;347:bmj.f3288
  1. Julie Iddon1,
  2. J Michael Dixon2
  1. 1East Lancashire Hospitals NHS Trust, Lancashire, UK
  2. 2Western General Hospital Edinburgh Breast Unit Edinburgh, UK

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Overview

  • Breast pain alone or painful lumpiness is common and accounts for approximately 50% of all referrals of new patients to clinics

  • Breast pain is a rare symptom of breast cancer

  • Pain in the breast can arise from the breast or from the underlying chest wall

  • Careful examination can differentiate chest wall pain from true breast pain

  • Few patients with breast pain need treatment with drugs

Mastalgia is pain in the breast. Up to 70% of women will experience this at some time during their life. The pain women describe as breast pain can arise either in the breast tissue itself or it can be referred pain, which is felt in the breast. The nerve supply to the breast is from the anterolateral and anteromedial branches of the intercostal nerves from T3 to T5 and irritation of these nerves anywhere along their course can lead to pain that is felt in the breast or nipple. A branch of T4 penetrates the deep surface of the breast and runs up to the nipple. Irritation of this nerve can result in the shooting pain up to the nipple that many women describe. Pain can also be referred from the breast or chest wall through the intercostobrachial nerve to the inner aspect of the arm.

Breast pain is a rare symptom of breast cancer. In a 10-year survey in Edinburgh of 8504 patients presenting with breast pain as their major symptom, 220 (2.7%) were subsequently diagnosed with breast cancer. During this period 4740 patients …

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